Provider Relations Rep- GHP
Gateway Health Plan - Home, PA

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Gateway Health Plan has an excellent opportunity for a Provider Relationship Representative to join their team.

This is a home-office based position requiring extensive travel within the Berks, Cumberland, Mifflin, Dauphin, Juniata, Lebanon, and Perry County areas, including some overnight travel. Candidates must reside in this geography. The selected candidate will be provided with necessary office equipment and will receive mileage reimbursement for business travel.

Responsibilities for Provider Relationship Representative include:
  • Serve as the primary liaison between Gateway Health Plan and the participating provider community who service our members in multiple product lines throughout the state of Pennsylvania.
  • Build and maintain strong relationships with providers by offering excellent customer service to assigned hospitals, primary care, ob/gyn and specialty care physicians with routine and targeted education visits for the purpose of continued education regarding policies/initiatives. Service also includes supply deliveries and prompt follow up regarding claims, benefits and procedural guidelines for authorization of services.
  • Conduct on-site visits, telephonic conversations and written communications with individuals including Hospital CEO's and CFO's, Patient Account Managers, Physicians, Office and Billing Managers.
  • Conduct Environmental Assessments and ADA surveys for all newly credentialed PCP. Responsible for enforcing the required standards to ensure compliance.
  • Perform on-site provider orientations and group county orientations for new primary care, ob/gyn, and specialty care physicians regarding policies, procedures, billing and company-wide initiatives. Conduct hospital orientations/reorientations and work with the Hospital Specialist as necessary. Public speaking talent is essential.
  • Represent the Provider Relations Department in workgroups and committees that address both internal and external customer concerns regarding the operations of Gateway as it pertains to the provider community.
  • Other duties as assigned.
REQUIRED QUALIFICATIONS
  • 2 years of experience required in Provider Relations and/or Managed Care Product Administration
    Valid driver's license and automobile required.
  • Applicant must be highly proficient and creative at identifying and solving problems.
    Incumbent must be able to work independently as a telecommuter and attend off-site meetings; including overnight stays.
PREFERRED QUALIFICATIONS
  • Bachelor's degree in Business Administration, Marketing, Health Care Administration or Other Related Degree
  • 2 years Provider Relations experience or medical office or hospital experience
  • 2 years exposure to medical claims processing procedures
  • Knowledge and understanding of the dynamics of Managed Care environment, including capitation and reimbursement structure

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For many residents, Gateway Health Plan is the keystone to health care coverage in Pennsylvania. The company provides managed health care...